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Ask the cancer genetics team: medical and psychological considerations of a preventive mastectomy

The Susan F. Smith Center for Women's Cancers at Dana-Farber provides a variety of services to help patients and their families cope with the many physical, emotional, and spiritual challenges of a cancer diagnosis and its treatment. We are committed to helping patients regain a sense of control over their lives and feel their best throughout treatment and beyond.

Q: There has been a lot of information in the news lately about preventive mastectomy since Angelina Jolie's announcement. I have a strong family history of breast cancer. Should I consider having a similar operation?

A: The first step is to find out if you have an inherited predisposition to breast cancer. This is best done by seeing a cancer genetics counselor, who can talk with you about your family history and decide which genetic tests, if any, could be informative.

Q: What motivates women to have preventive mastectomies and when in their lives do they have them?

A: Women who are at high hereditary risk for breast cancer due to a gene mutation may decide to have a preventive mastectomy because:

They have young children, like Angelina Jolie, and want to increase the odds of being there to raise their children and see their grandchildren.

There is a diagnosis of breast cancer in a close family member, especially diagnosis at an early age. Some women think about the age at which a mother or grandmother developed breast cancer and decide to undergo a preventive mastectomy before they reach that age.

For some women, the anxieties around screening increase over time, and they find that they want something more permanent so that they don't have to worry when it is time to have a breast MRI or mammogram.

Preventive mastectomies are done most often on women in their 30s and 40s, but women at both ends of the age spectrum also have this surgery. In some cases, the decision to have this surgery depends on when a woman discovered her hereditary risk. In other cases, something in a woman's recent experience may have altered how she feels about having this surgery.

Q: I don't know if I will be supported by some of my family members and friends if I choose to have this surgery. How do I deal with that?

A: Usually, it is well-meaning family members, friends, or colleagues who want to spare you what they consider to be the difficulties of this surgery by suggesting that it is not necessary. However, only a woman who faces such risks truly understands the pros and cons of this decision, and this decision is individual for every woman. A woman and her sister may come to very different conclusions about whether breast surgery is the right choice or whether maintaining screening is the preferable way to deal with hereditary cancer risks. It may be helpful to gently remind friends or relatives that you will take their concerns into consideration and appreciate that they are thinking about you, but let them know that you have to make the decision that best fits your life and your worries, and you will appreciate their support of your decision.

Q: How do partners feel about their wives or girlfriends having a preventive mastectomy?

A:

Most women report that their decision to have a preventive mastectomy is supported by their partners. Women also report that their partners' main concern is reducing the risk of dying at a young age so they can grow old together.

However, we know that it is often difficult for spouses to discuss this option openly. It may be important for both spouses to acknowledge that while there are many good things about reducing hereditary risk for breast cancer through preventive mastectomy, there are losses involved, as well. The loss of the woman's breasts as part of the couple's sexual life together necessitates adaption. Some couples have talked about mourning that part of their life experience, and putting it into perspective, like aging, as a process that changes things, but does not reduce their mutual enjoyment.

Feeling closer to their partners for having gone through this experience together is a common report.

Many women say that after their surgical recovery, their husbands or partners found them as sexually attractive as they had before. Some women, nonetheless, find they need more time to feel comfortable in their changed bodies. If there are post-surgical adjustments that feel slow in coming, talking with a psychologist or other mental health professional may help integrate the many changes that occur.

If you are at high risk for breast cancer due to a genetic cause and are considering a preventive mastectomy, but would like to discuss psychological considerations, make an appointment with Cancer Genetics and Prevention Program psychologist, Andrea Patenaude, PhD, at 617-632-5577.

For patients who have undergone preventive mastectomy or bilateral salpingo-oophorectomy (removal of ovaries and fallopian tubes), Dana-Farber's Sexual Health Program is a resource for patients concerned about sexual health. For more information or to schedule an appointment, please call 617-632-4523.